Pediatric necrotizing enterocolitis (NEC)

What is pediatric necrotizing enterocolitis (NEC)?

NEC develops most often in the second to third week of life. There seems to be an interaction between lower birth weight and higher risk. It affects close to 10% of infants who weigh less than 3 pounds, 5 ounces but may also occur in term and near-term babies.

Sometimes the infection can become severe and cause damage to the intestines. In very severe cases, there can be a hole created in the wall of the intestines. This allows bacteria to get into the abdomen.

What are the signs and symptoms of pediatric necrotizing enterocolitis (NEC)?

Symptoms usually occur in the first 2-3 weeks of life and may include swelling of the abdomen, frequent vomiting that can be green in color, trouble feeding, blood in stool, temperature that can swing between being too high and too low, a lack of energy, also known as lethargy, redness or other strange color to the tummy, and problems breathing, such as irregular gaps in the rhythm.

NEC can be a very fast-moving condition and needs to be treated early.

How is pediatric necrotizing enterocolitis (NEC) diagnosed?

History and physical

The first step in diagnosing necrotizing enterocolitis is a thorough history and physical examination. Your child’s physician will look at the belly to see if it is large and extended, an indication of gas in the intestine. The doctor may look for redness or other color changes around the belly can help with the diagnosis.

The medical history is another important part of the early diagnosis. You will be asked about how often your baby has a bowel movement.

• Is there a red color that could be blood in the stool?

• Have you noticed changes in energy level?

• Is your baby feeding well?

Imaging (radiology)

If NEC is suspected, an X-ray of the abdomen will be taken. That can show your child’s doctor any blockages, excess gas or any holes (perforations) in the intestine. Doctors may need to take more than one X-ray to track the course of the disease.

Lab work

An elevated white blood cell count indicates an infection is happening. Low red cells can be a reason to suspect blood loss, as can low platelet counts.

Occult blood tests may be performed on your baby’s bowel movements. If blood is found, that can mean a hole (perforation) somewhere in the intestine that may require surgery.

What are the causes of pediatric necrotizing enterocolitis (NEC)?

Necrotizing enterocolitis is seen in only one out of 4,000 births in the United States. However, it is still the most common gastrointestinal emergency among premature infants in neonatal intensive care units (NICU). It can be fatal for some infants, so aggressive treatment is important.

Doctors don’t yet know the exact cause for NEC. Many think that low blood flow to the intestinal walls weakens them. This decrease in blood flow to the bowel keeps it from producing the mucus that protects the gastrointestinal tract.

Others believe that since it is seen so often in premature births, it may be related to the gut simply not being as mature as it would be closer to term.

How is pediatric necrotizing enterocolitis (NEC) treated?

Stop oral feedings

The first step is usually to stop all feedings by mouth. Instead, fluids and needed nutrients will be given intravenously. This allows the intestine to rest and takes away stress.

Often a tube will be inserted into your baby’s nose and into the stomach. This removes gas and air in the intestine. Bloating is reduced and your baby is more comfortable.

Medication

Next, doctors will start treatment with antibiotics. This will stop the infection and allow the bowel to heal.

Other treatments will depend on exactly what is happening. If there is bleeding, blood transfusions may be given. Medications may be used to keep blood pressure, heart rate and oxygen in the blood at proper levels.

Babies who do not need surgery during the acute infection occasionally develop obstructing scars in the intestine (strictures) that require operation later.

While these treatments are ongoing, tests will monitor your child’s health and help with further decisions.

They include:

• X-rays of the abdomen will track the amount of gas building up in the baby’s stomach.

• Blood tests will follow signs of infection (white blood cell counts), the efficiency of your baby’s breathing (blood gas studies measuring oxygen and carbon dioxide) and lactic acid (high levels suggest disease progression).

Surgery

If surgery is needed, the pediatric surgeon will look closely at the intestine. The doctor will take out only the damaged parts. This is done so that the remaining tissue can start to work again. It preserves, to the greatest amount possible, your child’s digestive system.

The surgeon may make an opening in the wall of the abdomen. This lets the bowel recover and heal. Routing the intestine so it empties into a bag (colostomy) outside of the body can be frightening for parents. However, this is most often temporary. Another surgery may be needed later to close the opening.